Demographic and Laboratory Features of Multiple Myeloma Patients with Renal Dysfunction

Amaç: Hastanemizde tanı alan myelom nefropatili olguların demografik ve laboratuvar özelliklerin prognostik etki- leri ile, uygulanan tedavilerin böbrek fonksiyonlarını düzeltici etkilerinin karşılaştırılmasını amaçladık. Yöntem ve Gereçler: Klinikte takip ettiğimiz 16 myelom nefropatili (12 erkek 4 kadın, yaş ortalaması 5617) olguyu retrospektif olarak inceledik. Hastaların demografik özellikleri laboratuar parametreleri değerlendirildi. Akut böbrek hasarı varlığı KDIGO kriterlerine göre belirlendi. Kemoterapi olarak 10 olguya VAD, 5 olguya MP protokolleri uygulandı. Serum kreatinin düzeyinde en az %25'lik düşme veya hemodiyaliz tedavisine ara verilenler tedaviye yanıt alınan olgular olarak kabul edildi. P0,05 istatistiksel olarak anlamlı kabul edildi. Bulgular: En sık başvuru şikayeti 10 olguda (%62,5) olan kemik (özellikle bel) ağrısıydı. Olguların hepsi ane- mikti ve böbrek hasarını tetikleyen faktörler olarak 13 olguda (%81,2) hiperürisemi, 9 olguda (%56,2) analjezik kullanımı, 6 olguda (% 37,5) hiperkalsemi, 6 olguda (% 37,5) dehidratasyon, 5 olguda, (%31,2) infeksiyon, 1 olguda (%6,2) kanama tespit edildi. Böbrek fonksiyonları düzelen olgularda yaş, cinsiyet, evre, myelom tipi, sedi- mentasyon, CRP, LDH, beta-2 mikroglobulin, kreatinin, total protein, albumin, hemoglobin, ürik asit, sodyum, proteinüri miktarı ve kemoterapi protokolünü böbrek fonksiyonları düzelmeyenlerden farklı bulmadık (P0.05). Serum kalsiyum düzeyi böbrek fonksiyonları düzelenlerde (13,51,7 mg/dl), düzelmeyenlerden (9,81,1 mg/dl) daha yüksekti (P0,05). Tartışma: Myelom nefropatili hastalarda ABHnın tıbbi destek tedavisi, gereken hastalarda hemodiyaliz ve kemo- terapi sonrası hastaların yaklaşık yarısında düzeldiği bildirilmektedir. Bizim hasta grubumuzda da tedavi sonucunda 7 olguda (%43,7) böbrek fonksiyonları düzeldi, Böbrek fonksiyonları düzelen olguların sadece 1'ine hemodiyaliz uygulandı, diğer 6 olguda hemodiyaliz ihtiyacı olmadı. Eğer kalsiyum düzeyleri tedavi ile aşağıya çekilebilirse böbrek fonksiyonları daha da düzelebilir. Bizim olgu gru- bumuzda serum kalsiyum düzeyleri yüksek olan (13.51.7 mg/dl),ve bu düzeyleri normale indirmek için tedavi uygulananlarda, kalsiyum düzeyi normal olan (9,81.1 mg/dl) gruba göre ABHda daha fazla düzelme saptadık (P0.05). Sonuç olarak; multipl myelomlu hastalarda sık görülen nefropati mortalite ve morbiditeyi belirgin olarak arttırdığın- dan, böbrek hasarını önlemeye yönelik önlemlere daha fazla önem verilmelidir.Aim: The aim of the present study was to compare demographic and laboratory features among patients diagnosed with myeloma nephropathy and compare efficiency of various therapies in improving kidney functions. Material and Methods: The medical records of 16 patients (12 males, 4 females, mean age was 56±17 years), who were followed at our clinic due to myeloma nephropathy, were retrospectively reviewed. Demographic features and laboratory parameters of the patients were evaluated. The presence of acute kidney injury was determined accord- ing to KDIGO criteria. As a chemotherapy protocol, 10 cases received VAD and 5 cases received MP protocols. The patients, who achieved at least 25% reduction in serum creatinine level or suspended hemodialysis, were considered responders. A p value 0.05). Serum calcium level was significantly higher in responders (13.5±1.7 mg/dl) compared to non-responders (9.8±1.1 mg/dl) (P<0.05). Discussion: It was reported that AKI was improved by supportive medical therapy, hemodialysis if indicated, and after chemotherapy in at least half of the patients with myeloma nephropathy. In the present patient group, kidney functions were improved with treatment in 7 patients (43.7%). Only one patient that showed improvement in kidney functions underwent hemodialysis, and the remaining six patients did not require hemodialysis. Further improvement in kidney functions can be obtained if lower calcium levels can be achieved with treatment. In the present study, patients with higher serum calcium levels (13.5±1.7 mg/dl) that received therapy to reduce se- rum calcium to normal levels achieved higher improvement in AKI compared to those with normal calcium levels (9.8±1.1 mg/dl) (P<0.05). In conclusion, nephropathy, a common finding in multiple myeloma, significantly increases mortality and morbidity, and more emphasis must be placed on measures to prevent kidney injury

Magnetic Iron-Doped Filtered Coffee Bio-Waste Based Carbon for the Adsorption of Reactive Blue 21

Intensive coffee consumption causes a high amount of coffee waste to be produced annually. In this study, the adsorption of Reactive Blue 21 (RB21) dye by using the magnetic iron-doped filtered coffee bio-waste (magnetic-FCW) was investigated in detail. Magnetic-FCW was characterised by SEM-EDX, mapping, FTIR, and Raman analysis and it was found that the material contains 3.4% Fe by weight. The highest RB21 removal was observed as 97.8% at pH 3 and 5 g/L magnetic-FCW concentration. It was determined that the adsorption of RB21 dye by magnetic-FCW was more describable by the pseudo second-order kinetic model, and k(2) was calculated as 0.086 and 0.0016 g/mg min at 50 and 100 mg/L RB21 concentrations, respectively. In addition, RB21 dye removal with magnetic-FCW was more amenable to the Langmuir isotherm model and the q(max) was calculated as 15.80 mg/g. In conclusion, the use of this bio-waste, which is formed as a result of the rapid increase in the consumption of filtered coffee, in the removal of dyes such as RB21 dye from wastewater, makes it possible to include magnetic-FCW in the field of waste management as a low-cost adsorbent material, which reduces operating costs and makes it possible to reuse these wastes in the waste sector. Collecting these bio-wastes, especially from cafes and restaurants and, reusing them could serve the circular economy as well

Comparison of Conventional and Ultrasonic-Assisted Adsorption Processes by Using H3PO4 Activated Cypress Tree Cone for Methylene Blue Removal (vol 44, pg 269, 2022)

[Abstract Not Available

Exploring the reusability of cuttlefish bones in sustainable waste management by green synthesis method for methylene blue dye removal

The use of solid wastes as an adsorbent for dye removal from wastewater is one of the leading steps of sustainable waste management. In this research, the removal of Methylene Blue dye by cuttlefish bone waste was examined by using peppermint extract. Zn-doped cuttlefish bone was prepared by the green synthesis method in laboratory conditions for the comparison of cuttlefish bone in adsorption and ultrasonically-assisted adsorption processes. The results of this study exhibited that Methylene Blue removal with Zn-doped cuttlefish bone was higher than that with cuttlefish bone at all pH values. The qmax values obtained from the Langmuir isotherm model were calculated as 8.96 mg/g and 12.74 mg/g in the adsorption process with cuttlefish bone and Zn-doped cuttlefish bone, respectively. The qmax value relatively improved to 18.05 mg/g in the ultrasonically-assisted adsorption with Zn-doped cuttlefish bone. With the green synthesis, the qmax increased by 1.42 times, while this increase was 2.01 times with the application of the ultrasonically-assisted adsorption process using Zn-doped cuttlefish bone compared to the adsorption process using cuttlefish bone. © 2023 Informa UK Limited, trading as Taylor & Francis Group

EXPLORING THE EFFECT OF COVID-19 ON MUNICIPAL WASTE GENERATION WITH SYSTEM DYNAMICS MODELLING

This study examines the dynamic change in population and municipal waste generation during the COVID-19 pandemic. A stockflow infection modelling was used to link population dynamics with disease transmission parameters (such as probability to catch COVID-19 and population interactions) to estimate municipal waste generation in the province of Tekirdag, Turkey. Three different scenarios (Scenario 1: severe conditions with possible mutation of coronavirus, Scenario 2: moderate conditions with the continuation of the current case and Scenario 3: mild conditions with intensified vaccination) were produced and simulation results were analysed. The results show that it is expected to have a peak with 230 000 people with severe symptoms in Scenario 1. It is also expected to have 1 person/week to pass away due to inadequate health infrastructure if the annual healthcare capacity improvement rate in the province remains at its current rate (1%). The results indicate that the amount of dry recyclables increases over time in the three scenarios. However, in Scenario 3, a total of 450 000 - 780 000 tonnes of dry recyclables are expected to be produced at the end of 3 years. This high amount of waste is likely to cause dynamism in the recycling activities of the province. As far as it is concerned that 750 000 - 1 000 000 tonnes of residual waste (including used masks) are expected to be produced in Scenario 3, capacity improvement for the only landfill site of the province should be made urgently or an alternative solid waste disposal facility should be put into use to meet this need

The Case of Hyperlipidemia is Associated With Widespread Eruptive Xanthoma

Tüm dünyada özellikle gelişmiş ülkelerdeki mortalite ve morbiditenin en önemli nedeni olan aterosklerozun risk faktörlerinin başında hiperlipidemi gelmektedir. Hiperlipidemili hasta asemptomatik olacağı gibi aterosklerotik kalp hastalığı, pankreatit, safra taşı, ksantom, ksantelesma, lipemia retinalis, steatohepatit gibi çeşitli semptomlarla da karşımıza çıkabilir. Bu hastalarda öykü ve fizik muayeneyi takiben koroner kalp hastalığı açısından bireysel risk faktörlerinin değerlendirilmesi ve plazma lipitlerinin ölçülmesi gerekir. Yüksek plazma lipitleri deri, tendonlar, göz, karaciğer ve dalak gibi çeşitli dokularda makrofajlar içerisinde birikerek fizik muayenede kolayca fark edilebilirler. Hastaların büyük kısmında diyet, egzersiz ( yaşam tarzı değişiklikleri)ve ilaç tedavisi ile başarılı sonuçlar elde edil- mektedir. Bizim olgumuz 8 yıldır Tip 2 diyabet nedeniyle insülin, nefropati nedeniyle anjiyotensin konverting enzim inhibitörü kullanan fenofibrat ve statin tedavisine rağmen trigliserit düzeyi 2000 mg/dL, total kolesterol düzeyi 600 mg/dL olan 33 yaşında kadındı. Hastanın bilateral palmar bölge ile diz, dirsek ve gluteal bölgelerinde erüptif ksan- tom ile uyumlu yaygın cilt lezyonlarının olduğu tespit edildi. Hiperlipidemiye bağlı bu kadar yaygın ksantomlar nadir görüldüğü için olgu sunumu yapılmaya değer görüldü.All over the world, especially developed countries the most important cause of morbidity and mortality in at the beginning of the risk factors of atherosclerosis is hyperlipidemia. Patients with HL may be asymptomatic as may be appeared CVD, pancreatitis, gallstones, xanthoma, ksantelesma, lipemia retinalis, steatohepatitis in a variety of symptoms. In this patients followed by history and physical examination should be measured individually plasma lipids with risk factors for coronary heart disease. High plasma lipids is accumulated in macrophages in various tissues;skin, tendons, eyes such as the liver and spleen can be easily noticed on physical examination. The majority of patients diet, exercise, and drug therapy are successfully corrected. In our case; a 33-year-old female despite treat- ment with insulin (due to diabetes type 2) angiotensin-converting enzyme inhibitors for nephropathy,fenofibrate and statin, triglyceride level 2000 mg / dL, total cholesterol level of 600 mg / dL. Our patient's common skin lesions in Palmar region, bilateral knee, elbow and gluteal region were found to be compatible with the eruptive xanthoma. So common Xanthomas due to hyperlipidemia are to be seen rare case report was worth doin

Bone-minerale metabolism disorders (renal osteodystrophy) in chronic kidney disease and treatment approach

Kronik böbrek hastalığında devam eden parankim kaybı nedeniyle böbrek fonksiyonları azaldıkça kemik-mineral metabolizmasında bozulmalar olmaktadır. Bu durumu oluşturan temel neden sekonder hiperparatiroididir ve bu tabloya da renal osteodistrofi denilmektedir. Bu tabloda vitamin D eksikliği, fosfat retansiyonu, hipokalsemi, sekonder hiperparatiroidinin oluşturduğu mineral metabolizması bozukluğu, kemik yapısında bozulma ile beraber vasküler ve/veya yumuşak doku kalsifikasyonları, metastatik kalsifikasyonlar söz konusudur. Renal osteodistrofi kronik böbrek hastalarında hem yaşam kalitesini düşürmesi hem de yaşam süresini kısaltıyor olması nedeniyle önem arz etmektedirWhen renal functions decrease with the ongoing parenchymal loss in chronic renal disease impairement of bone- mineral metabolism occurs. Secondary hyperparathyroidism is there all cause of this situation, and this case is called renal osteodystrophia. In this disease there are vitamin D deficiency, phosphate retension, hypocalcemia, mineral metabolism impairement due to secondary hyperparathyroidism, disturbance in the bone structure and vascular and/or soft tissue calcification, metastatic calcifications. Renal osteodystrophia is important in chronic kidney disease patients as it not only disturbs the quality of life of the patients but also decreases the survey of the patient

Celiac Crisis: A Rare and Serious Condition Resulting in Death

Celiac disease is an autoimmune disease of the small intestine, resulted from villusdamage and malabsorbtion due to ingestion of gluten; and production of antibodies to gliadin. Thedisease can manifest with various presentations. Celiac crisis was described as an acute, serious,life-threatening form of celiac disease about sixty years ago with a higher incidence among pediatric patients than adults. It is characterized by gastrointestinal symptoms like profuse diarrhea andsevere metabolic distubances like hyponatremia and hypoproteinemia. Early suspicion and detection is important. This case report presents a 54-year-old female patient who died from celiac crisis and sepsis

A Case Report: Hypersensitivity Pneumonia

Nefes darlığı, öksürük semptomları ile gelen PA akciğer grafisi doğal olan ancak detaylı anamnezle güvercin maruziyeti öyküsü tarifleyen ve hipersensitivite pnömonisi tanısı alan olguyu sunduk. 66 yaşında erkek hasta üç aydır olan nefes darlığı, öksürük şikayetleri ile polikliniğine başvurdu. Fizik muayenesinde solunum sesleri doğaldı. Çevresel, mesleksel maruziyet ve özellikli bir ilaç kullanım öyküsü yoktu. PA akciğer grafisi normaldi. Toraks yüksek çözünürlüklü bilgisayarlı tomografi (YÇBT)'de orta ve alt loblarda daha belirgin olan yaygın buzlu cam dansitesinde sentriasiner nodüller izlendi. Hastanın evin çatısındaki güvercinlere ait atık ürünlerini haftalık temizlediği öğrenilmesi üzerine güvercinlerle direk ve dolaylı maruziyetinin kesilmesi önerildi. Bir ay sonraki kontrolünde öksürük ve nefes darlığı semptomlarında gerileme olduğu öğrenildi. Kontrol toraks YÇBT'de her iki akciğerde izlenen yaygın sentriasiner nodüllerin kaybolduğu görüldü. Nefes darlığı, öksürük gibi semptomlarla başvuran hastalarda akciğer grafisi normal bile olsa hipersensitivite pnömonisinin de olabileceği göz önünde bulundurulmalı ve hastaların maruziyet öyküsü detaylı olarak sorgulanmalıdırA case of hypersensitivity pneumonitis with symptoms of dyspnea and cough, with normal PA chest radiography and with the anamnesis of pigeon exposure was presented here. 66 years old male patient had complaints of dyspnea and cough since 3 months. His respiratory sounds were normal. He did not have other environmental, occupational or drug exposure history. In thorax high resolution computed tomography (HRCT), there were centriacinar nodules in the middle and lower lobes. When his anamnesis was reevaluated, we learned that he was cleaning up pigeon droppings from roof every week. The patient was instructed to stop having direct and indirect contact with pigeons. One month after, the patient was reevaluated. His cough and dyspnea were improved. In his followup thorax HRCT, centriacinar nodules were disappeared. We should always consider hypersensitivity pneumonitis in the patients with the complaints of dyspnea, cough, even if the PA radiography is normal; we should take the exposure history comprehensivel

Late onset congenital adrenal hyperplasia with incoming hirsutism

Konjenital adrenal hiperplazi adolesan dönemden sonra daha az görülmektedir ve bu geç başlangıçlı olan vakalar daha çok oligomenore ve hirsutizm nedeniyle araştırılırken tanı almaktadırlar. Özellikle polikistik over sendromu nedeniyle poliklinikte araştırılan kadın hastalarda bu tanının da göz önünde bulundurulmasına dikkat edilmelidir.Congenital adrenal hyperplasia are less frequent after the adolescent period and late-onset cases that are mostly diagnosed in the course of investigating for oligomenorhea and hirsutism. Female patients who evaluated in the clinics for especially polycystic ovary syndrome should be taken into account this diagnosis in with consideration